Predicting the outcome in patients with unexplained syncope and suspected cardiac cause: role of electrophysiologic
Mohammad Assadian Rad1, Mohammad Farahani, Zahra Emkanjoo
1Cardiovascular Research Center, Guilan University of Medical Sciences; Rasht-Iran. emkanjoozahra@gmail.com.
Insights
Abnormal electrophysiology study results, particularly left bundle branch block (LBBB), predict poor prognosis in syncope patients with suspected cardiac causes. However, those with structural heart disease and negative studies show good long-term outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Medicine
Background:
- Unexplained syncope presents a diagnostic challenge for electrophysiologists.
- Prognosis in syncope patients varies significantly based on underlying causes, especially cardiac etiologies.
Purpose of the Study:
- To identify abnormal electrophysiologic (EP) study results as predictors of prognosis in syncope patients with suspected cardiac causes.
- To determine risk factors associated with mortality in this patient population.
Main Methods:
- Prospective enrollment of 227 consecutive patients with unexplained syncope.
- Electrophysiology study (EP study) performed in 177 patients; head-up tilt test (HUTT) used if EP study was negative.
- Complete follow-up obtained for 132 patients over a mean of 20.0±10.8 months.
Main Results:
- A cardiac cause was identified in 35% of patients, neurally mediated syncope in 35.6%, with 29.4% remaining unexplained.
- Absence of prodromal symptoms, left bundle branch block (LBBB), severe left ventricle (LV) dysfunction, and male gender predicted a cardiac cause.
- LBBB presence was significantly associated with mortality (Odds Ratio=6.63).
Conclusions:
- Abnormal EP study results, LBBB, and structural heart disease (SHD) are valuable prognostic indicators in syncope patients with suspected cardiac origins.
- Patients with SHD and unexplained syncope, despite negative EP studies and LV dysfunction, exhibit favorable long-term prognoses.
Objective:
Unexplained syncope is a challenge facing electrophysiologists. The prognosis varies widely depending on underlying causes, specially, cardiac ones. We sought to determine the abnormal electrophysiolgic (EP) study results as predictors of prognosis in syncope patients with suspected cardiac cause and risk factors associated with mortality.
Methods:
A total of 227 consecutive patients with unexplained syncope were prospectively enrolled in this study. EP study was performed in 177 patients in base of inclusion criteria. These patients, in whom a cardiac cause of syncope was suspected, underwent EP study and if negative, head-up tilts test (HUTT). Complete follow-up was obtained for 132 patients for 20.0±10.8 months.
Results:
A cardiac cause of syncope was established in 35%, a neurally mediated syncope in 35.6%, and in the rest 29.4% the cause of syncope remained unexplained despite a throughout neurologic and cardiologic evaluation. Logistic analysis revealed that the significant predictors of a cardiac cause of syncope were the absence of prodromal symptoms, left bundle branch block (LBBB), sever left ventricle (LV) dysfunction and male gender. At logistic analysis, the presence of LBBB (OR=6.63; 95% CI: 1.09-40) was significantly associated with outcome of death.
Conclusion:
The present study provides evidence that presence of LBBB, abnormal EP study result and structural heart disease (SHD) have prognostic value in patients with suspected cardiac cause of syncope. The patients with SHD and unexplained syncope who had a negative EP study have a good long-term prognosis even in the presence of LV dysfunction.
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